JCPSLP Vol 20 No 2 July 2018

discharge criteria (i.e., no longer requiring speech sound intervention of any kind). Of the remaining participants in the treatment group six participants were discharged, as target sounds were being produced at a conversational level, and only three required further therapy. Of the remaining participants in the control group, five participants were discharged as target sounds were being produced at a conversational level, and three required further therapy. Discussion The incorporation of ultrasound technology into speech- language pathology practice resulted in a range of positive outcomes for the speech-language pathologists, participants and parents/carers. Our observation is that with the incorporation of ultrasound into traditional articulation therapy comes increased motivation, engagement, and metalinguistic knowledge for the participant, while for the speech-language pathologists the ability to see lingual position and movement provides more specific feedback and accurate cueing. These observations are, as yet, only observations and further evaluation of the potential benefits of ultrasound use in speech pathology practice is needed. During the course of our study we learnt that similar issues as regularly faced within traditional intervention also occurred within this project and impacted on success for some clients. These issues included reduced adherence to therapy, the continued need for drill practice of speech targets, reduced attention, and reduced engagement for some participants. Ultrasound technology does not solve these familiar barriers to success. Speech- language pathologists need to take into consideration the suitability of each child for therapy including ultrasound. Factors that may impact children’s suitability for ultrasound- based therapy include age, physical size for comfort, ease of ultrasound probe use, self-awareness and evaluation skills, motivation, and timing of intervention. Even though the treatment regime may differ, barriers to engagement in intervention remain the same. The results of this project demonstrated improvements in speech sound production for both the control and the participant group. Although statistical significance in the PCC achieved by the participant group when compared with the control group (p = 0.054) was not achieved, it is possible that with a larger sample size a significant difference may have been recorded. Earlier improvement in the ultrasound treatment group, as compared to the control group, in accurate production of target words was observed. Given the relatively small numbers used in this study, to observe this effect does suggest that there are benefits in the use of the technology. There was also progressive improvement in the significance of the outcomes as the participants became older (i.e., older participants in the group utilising ultrasound responded more readily to intervention), although there is the possibility that this may can be attributed to the normalisation or natural recovery of speech sound errors as children become older. Studies targeted specifically at observing the differences in outcomes to speech pathology intervention incorporating visual feedback provided by ultrasound across different age groups would allow for more targeted use of this technology. Although the absence of a significant difference in treatment outcomes between the treatment and control groups does not prove our

Table 2. Percentage of consonants correct and percentage of target words correct pre- and post- treatment

Treatment (n =9)

Control (n =8)

p

Number of sessions attended (median IQR) % Consonants correct (median IQR)

8 (7–10)

8 (6.5–9)

.84

Pre

90 (87–94)

90 (80.3–92.5)

.50

Post

98 (96.8–100)

94 (88.5–98)

.13

% Target words correct (median IQR)

Pre

10 (0–20)

2.5 (0–35)

.70

Mid

80 (67.5–87.5)

25 (0–57.5)

.04

Post

90 (80–100)

90 (25–97.5)

.37

100 90 80 70 60 50 40 30 20 10 0

90

80

25

Number of participants

10

2.5

Pre

Mid

Post

Treatment Group

Control Group

“neutral” and “happy” responses were recorded. There was a small increase in the number of “happy” responses as recorded by parents/carers. There was a small decrease in the number of children who recorded a “happy” response. The reason for this is not known. A significant difference in the post-treatment intelligibility ratings between the control and the treatment groups ( p = 0.039), as recorded by the speech-language pathologist investigator was noted. There was no significant difference between the pre, mid and post scores on any other perceptual measures recorded. Following intervention, the percentage of target words produced correctly ranged from 45% to 100% in the treatment groups, and 10 to 100% in the control groups. Although all groups improved in skill by the project’s end, analysis suggests that the treatment group were able to produce targeted sounds more rapidly than the control group (see Figure 5). There was no significant difference in improvements in percentage of target words produced between the treatment and the control groups. At the conclusion of the study, both treatment and control groups yielded similar outcomes in terms of meeting Figure 5. Median percentage of target words produced correctly at pre-assessment, mid-assessment and post-assessment

80

JCPSLP Volume 20, Number 2 2018

Journal of Clinical Practice in Speech-Language Pathology